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Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis


Acute Myeloid Leukemia (AML) has a median age at diagnosis of 67 years. The most common curative therapy remains an allogeneic hematopoietic stem cell transplantation (HCT), yet it is complicated by treatment-related mortality (TRM) and ongoing morbidity including graft versus host disease (GVHD) that may impact survival, particularly in older patients. We examined the outcomes and predictors of success in 1321 patients aged 60 years and older receiving a HCT for AML in first complete remission (CR1) from 2007-2017 and reported to the CIBMTR. Outcomes were compared in three age cohorts (60–64; 65–69; 70+). With median follow-up of nearly 3 years, patients aged 60–64 had modestly, though significantly better OS, DFS and lower TRM than those either 65–69 or 70+; cohorts with similar outcomes. Three-year OS for the 3 cohorts was 49.4%, 42.3%, and 44.7% respectively (p = 0.026). TRM was higher with increasing age, cord blood as graft source and HCT-CI score of ≥3. Conditioning intensity was not a significant predictor of OS in the 60-69 cohort with 3-year OS of 46% for RIC and 49% for MAC (p = 0.38); MAC was rarely used over age 70. There was no difference in the relapse rate, incidence of Grade III/IV acute GVHD, or moderate-severe chronic GVHD across the age cohorts. After adjusting for other predictors, age had a small effect on OS and TRM. High-risk features including poor cytogenetics and measurable residual disease (MRD) prior to HCT were each significantly associated with relapse and accounted for most of the adverse impact on OS and DFS. Age did not influence the incidence of either acute or chronic GVHD; while graft type and associated GVHD prophylaxis were most important. These data suggest that age alone is not a barrier to successful HCT for AML in CR1 and should not exclude patients from HCT. Efforts should focus on minimizing residual disease and better donor selection.

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Fig. 1: Survival outcomes of 1321 AML undergoing HCT in CR1.
Fig. 2: Relapse and treatment related mortality.
Fig. 3: Graft versus host disease.


  1. Oran B, Weisdorf DJ. Survival for older patients with acute myeloid leukemia: a population-based study. Haematologica. 2012;97:1916–24.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pollyea DA, Kohrt HE, Medeiros BC. Acute myeloid leukaemia in the elderly: a review. Br J Haematol. 2011;152:524–42.

    Article  Google Scholar 

  3. Estey E, de Lima M, Tibes R, Pierce S, Kantarjian H, Champlin R, et al. Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Blood. 2007;109:1395–1400.

    Article  CAS  PubMed  Google Scholar 

  4. Flannelly C, Tan BEX, Tan JL, McHugh CM, Sanapala C, Lagu T, et al. Barriers to hematopoietic cell transplantation for adults in the united states: a systematic review with a focus on age. Biol Blood Marrow Transplant. Published online 20 Sept 2020.

  5. Bhatt VR, Chen B, Lee SJ. Use of hematopoietic cell transplantation in younger patients with acute myeloid leukemia: a national cancer database study. Bone Marrow Transpl. 2018;53:873–9.

    Article  CAS  Google Scholar 

  6. Wallen H, Gooley TA, Deeg HJ, Pagel JM, Press OW, Appelbaum FR, et al. Ablative allogeneic hematopoietic cell transplantation in adults 60 years of age and older. J Clin Oncol. 2005;23:3439–46.

    Article  PubMed  Google Scholar 

  7. Rashidi A, Ebadi M, Colditz GA, DiPersio JF. Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia: a systematic review and meta-analysis. Biol Blood Marrow Transpl. 2016;22:651–7.

    Article  Google Scholar 

  8. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transpl. 2009;15:1628–33.

    Article  Google Scholar 

  9. Sorror ML, Storer BE, Fathi AT, Gerds A, Medeiros BC, Shami P, et al. Development and validation of a novel acute myeloid leukemia–composite model to estimate risks of mortality. JAMA Oncol. 2017;3:1675–82.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pohlen M, Groth C, Sauer T, Görlich D, Mesters R, Schliemann C, et al. Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (60 years). Bone Marrow Transpl. 2016;51:1441–8.

    Article  CAS  Google Scholar 

  11. Hourigan CS, Dillon LW, Gui G, Logan BR, Fei M, Ghannam J, et al. Impact of conditioning intensity of allogeneic transplantation for acute myeloid leukemia with genomic evidence of residual disease. J Clin Oncol. Published online 20 Dec 2019:JCO.19.03011.

  12. De Jong CN, Meijer E, Bakunina K, Nur E, van Marwijk Kooij M, de Groot MR, et al. Post-transplantation cyclophosphamide after allogeneic hematopoietic stem cell transplantation: results of the prospective randomized HOVON-96 trial in recipients of matched related and unrelated donors. Blood. 2019;134:1–1.

    Article  Google Scholar 

  13. Lee SJ, Logan B, Westervelt P, Cutler CC, Woolfrey AE, Khan S, et al. 5 year results of BMT CTN 0201: unrelated donor bone marrow is associated with better psychological well-being and less burdensome chronic gvhd symptoms than peripheral blood. Blood. 2015;126:270.

    Article  Google Scholar 

  14. Thein MS, Ershler WB, Jemal A, Yates JW, Baer MR. Outcome of older patients with acute myeloid leukemia. Cancer. 2013;119:2720–7.

    Article  PubMed  Google Scholar 

  15. Bhatt VR, Chen B, Gyawali B, Lee SJ. Socioeconomic and health system factors associated with lower utilization of hematopoietic cell transplantation in older patients with acute myeloid leukemia. Bone Marrow Transpl. 2018;53:1288–94.

    Article  CAS  Google Scholar 

  16. Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu Z, Adekola K, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood. 2017;130:1156–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ustun C, Le-Rademacher J, Wang HL, Othus M, Sun Z, Major B, et al. Allogeneic hematopoietic cell transplantation compared to chemotherapy consolidation in older acute myeloid leukemia (AML) patients 60–75 years in first complete remission (CR1): an alliance (A151509), SWOG, ECOG-ACRIN, and CIBMTR study. Leukemia. 2019;33:2599–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL, et al. Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes. J Clin Oncol. 2017;35:1154–61.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Finke J, Nagler A. Viewpoint: What is the role of allogeneic haematopoietic cell transplantation in the era of reduced-intensity conditioning—is there still an upper age limit? A focus on myeloid neoplasia. Leukemia. 2007;21:1357–62.

    Article  CAS  PubMed  Google Scholar 

  20. Hegenbart U, Niederwieser D, Sandmaier BM, Maris M, Shizuru JA, Greinix H, et al. Treatment for acute myelogenous leukemia by low-dose, total-body, irradiation-based conditioning and hematopoietic cell transplantation from related and unrelated donors. J Clin Oncol. 2006;24:444–53.

    Article  CAS  Google Scholar 

  21. Deeg HJ, Storer B, Slattery JT, Anasetti C, Doney KC, Hansen JA, et al. Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome. Blood J Am Soc Hematol. 2002;100:1201–7.

    CAS  Google Scholar 

  22. Ditschkowski M, Elmaagacli AH, Trenschel R, Steckel NK, Koldehoff M, Beelen DW. Myeloablative allogeneic hematopoietic stem cell transplantation in elderly patients. Clin Transpl. 2006;20:127–31.

    Article  CAS  Google Scholar 

  23. Polverelli N, Tura P, Battipaglia G, Malagola M, Bernardi S, Gandolfi L, et al. Multidimensional geriatric assessment for elderly hematological patients (≥60 years) submitted to allogeneic stem cell transplantation. A French–Italian 10-year experience on 228 patients. Bone Marrow Transplant. Published online 12 May 2020:1–10.

  24. Munshi PN, Vesole D, Jurczyszyn A, Zaucha JM, St Martin A, Davila O, et al. Age no bar: a CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma. Cancer.

  25. D’Souza A, Fretham C, Lee SJ, Arora M, Brunner J, Chhabra S, et al. Current use of and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transpl. 2020;26:e177–e182.

    Article  Google Scholar 

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The CIBMTR is supported primarily by Public Health Service U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); HHSH250201700006C from the Health Resources and Services Administration (HRSA); and N00014-20-1-2705 and N00014-20-1-2832 from the Office of Naval Research; Support is also provided by Be the Match Foundation, the Medical College of Wisconsin, the National Marrow Donor Program, and from the following commercial entities: AbbVie; Actinium Pharmaceuticals, Inc.; Adaptive Biotechnologies Corporation; Adienne SA; Allovir, Inc.; Amgen, Inc.; Angiocrine Bioscience; Astellas Pharma US; Bluebird Bio, Inc.; Bristol Myers Squibb Co.; CSL Behring; CytoSen Therapeutics, Inc.; Daiichi Sankyo Co., Ltd.; Eurofins Viracor; ExcellThera; Fate Therapeutics; Gamida-Cell, Ltd.; Genentech Inc; GlaxoSmithKline; Incyte Corporation; Janssen/Johnson & Johnson; Jasper Therapeutics; Jazz Pharmaceuticals, Inc.; Karyopharm Therapeutics; Kiadis Pharma; Kite, a Gilead Company; Kyowa Kirin; Legend Biotech; Magenta Therapeutics; Medac GmbH; Merck & Co.; Millennium, the Takeda Oncology Co.; Miltenyi Biotec, Inc.; MorphoSys; Novartis Pharmaceuticals Corporation; Omeros Corporation; Oncoimmune, Inc.; Orca Biosystems, Inc.; Pfizer, Inc.; Pharmacyclics, LLC; Sanofi Genzyme; Seagen, Inc.; Stemcyte; Takeda Pharmaceuticals; Tscan; Vertex; Vor Biopharma; Xenikos BV.

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Correspondence to Daniel Weisdorf.

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Daniel Weisdorf reports grants from FATE Therapeutics, grants from Incyte, outside the submitted work. Christopher S Hourigan reports other from Sellas, outside the submitted work. Joseph E Maakaron reports other from CRISPR, other from FortySeven Inc., other from TALARIS, outside the submitted work. Marcos de Lima reports grants from Pfizer grants from Celgene, personal fees from Kadmon personal fees from Pfizer, personal fees from Incyte, personal fees from BMS, outside the submitted work. Vijaya Raj Bhatt reports personal fees from Agios, grants and personal fees from Incyte, personal fees from Takeda, personal fees from Partner Therapeutics, personal fees from Omeros, grants and personal fees from Abbvie, grants from Jazz, grants from National Marrow Donor Program, other from Oncoceutics, personal fees from Partnership for health analytic research, LLC, grants and other from Pfizer, personal fees from CSL Behring, grants from Tolero Pharmaceuticals, personal fees from Rigel Pharmaceuticals, other from Novartis, personal fees from Genentech, outside the submitted work. Ayman Saad reports personal fees from Magenta Therapeutics, personal fees from Incyte Pharmaceuticals, personal fees from CareDx, outside the submitted work. Partow Kebriaei reports grants from Amgen, grants from Ziopharm, other from Kite, other from Novartis, other from Jazz, other from Pfizer, outside the submitted work. Celalettin Ustun reports not relevant, but honoria from Novartis and Blueprint for attending advisory board meeting. Fiona He reports personal fees from Magenta Therapeutics, outside the submitted work. Sunil Abhyankar reports other from Incyte Corporation, other from Therkos, outside the submitted work. Navneet Majhail reports personal fees from lncyte, personal fees from Anthem, Inc., personal fees from Nkarta, personal fees from Mallinckrodt, outside the submitted work.

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Maakaron, J.E., Zhang, MJ., Chen, K. et al. Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis. Bone Marrow Transplant 57, 911–917 (2022).

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